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NPI Code Detail

MEDICARE: JEWELIA ELLIS RN

MEDICARE: JEWELIA ELLIS RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WA0400XAddiction (Substance Use Disorder) Registered NurseRN523736OH

General Provider Information

NPI Number : 1003625682
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEWELIA ELLIS RN
Provider Business Mailing Address
First Line : 177 LEE DR
Second Line :
City : MONROE
State : OH
Zip : 45050-1606
Country : US
Telephone Number : 513-816-3200
Fax Number :
Provider Business Practice Location Address
First Line : 4977 NORTHCUTT PL
Second Line :
City : DAYTON
State : OH
Zip : 45414-3839
Country : US
Telephone Number : 800-829-5461
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2025
Last Update Date : 02/17/2026

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